What causes anaphylactic shock. Causes, symptoms and treatment of anaphylactic shock

Anaphylactic shock (from the Greek "reverse protection") is a generalized rapid allergic reaction that threatens human life, because it can develop within a few minutes. The term has been used since 1902, when it was first described in terms of dogs.

The presented pathology occurs in women and men,

old people and children with the same frequency.

Lethal outcome may occur

in approximately 1% of all patients.

Development of anaphylactic shock: causes

Various factors can cause anaphylactic shock: animals, drugs, food.

The main causes of anaphylactic shock

The state of anaphylactic shock in the body

The pathogenesis of the disease is quite complex and includes three successive stages:

immunological;

pathochemical;

pathophysiological.

Pathology is based on the contact of a certain allergen with immune cells, as a result of which specific antibodies (Ig E, Ig G) are released. These antibodies provoke a large release of inflammatory factors (leukotrienes, prostaglandins, heparin, histamine, etc.). Then the factors inflammatory process penetrate into all tissues and organs, causing a violation of coagulation and blood circulation in them to such serious complications as acute heart failure and cardiac arrest. Usually, the manifestation of any allergic reaction is possible only with repeated exposure to the allergen on the body. The danger of anaphylactic shock lies in the fact that it can develop even if the allergen first enters the body.

Symptoms of anaphylactic shock

Variations in the course of the disease:

Abortive is the easiest option, in which there is no threat to worsen the patient's condition. Anaphylactic shock does not provoke residual effects, it is easily stopped.

Prolonged - develops with the use of long-acting drugs (bicillin, etc.), so monitoring the patient and intensive care needs to be extended by a few days.

Malignant (fulminant) - has a very rapid development of acute respiratory and cardiovascular failure in a patient. Regardless of the operation performed, it is characterized by a lethal outcome in 90% of cases.

Recurrent - is in the nature of recurring episodes of the pathological condition for the reason that without the knowledge of the patient, the allergen continues to enter the body.

During the development of symptoms of the disease, doctors distinguish 3 periods:

Period of harbingers

At first, patients feel headache, nausea, dizziness, general weakness, rashes on the mucous membranes and skin in the form of urticaria blisters may occur.

The patient complains of a feeling of discomfort and anxiety, numbness of the hands and face, lack of air, deterioration of hearing and vision.

peak period

He is characterized by loss of consciousness, a fall blood pressure, general pallor, increased heart rate (tachycardia), noisy breathing, cyanosis of the extremities and lips, cold sticky sweat, itching, urinary incontinence, or vice versa, the cessation of its excretion.

Recovery period from shock

May continue for several days. Lack of appetite, dizziness, weakness in patients persist.

Severity of the condition

With mild flow

At mild form anaphylactic shock precursors usually develop within 10-15 minutes:

Quincke's edema of diverse localization;

burning and feeling of heat in the whole body;

urticaria, erythema, pruritus.

The patient manages to tell others about his feelings with mild anaphylactic shock:

Feeling pain in the lower back, headache, numbness of the fingers, lips, tongue, dizziness, fear of death, lack of air, general weakness, decreased vision, pain in the abdomen, chest.

There is pallor or cyanosis of the skin of the face.

Some patients may develop bronchospasm, characterized by labored exhalation and resonant wheezing that can be heard from a distance.

In most cases, abdominal pain, diarrhea, vomiting, defecation, or involuntary urination are observed. But at the same time, patients remain conscious.

Tachycardia, muffled heart sounds, thready pulse, sharply reduced blood pressure.

For moderate flow

Harbingers:

Involuntary urination and defecation, dilated pupils, pallor skin, cold sticky sweat, cyanosis of the lips, urticaria, general weakness, Quincke's edema - as with mild leakage.

Often - clonic and tonic convulsions, after which the person loses consciousness.

Pressure is not determined or very low, bradycardia or tachycardia, muffled heart sounds, thready pulse.

Rarely - bleeding from the nose, gastrointestinal, uterine bleeding.

Severe course

There are five clinical forms of the disease:

Asphyxic - with this form of pathology, patients are dominated by signs of bronchospasm (hoarseness, difficulty breathing, shortness of breath) and respiratory failure, Quincke's edema often occurs (severe swelling of the larynx, the development of which can stop a person's breathing).

Abdominal - the predominant symptom is abdominal pain that mimics the symptoms of a perforated gastric ulcer (due to spasm of intestinal smooth muscles) or acute appendicitis, diarrhea, vomiting.

Cerebral - this form is characterized by the development of edema of the brain and meninges, which manifests itself in the form of a state of coma or stupor, nausea and vomiting, which does not give relief, convulsions.

Hemodynamic - diagnostic symptom This form is a rapid drop in blood pressure and pain in the region of the heart, which is similar to myocardial infarction.

Generalized (typical) - the most common clinical form of anaphylactic shock, which includes general manifestations of the disease.

Diagnosis of anaphylactic shock

Pathology needs to be diagnosed as soon as possible.

after all, in many respects the question of the patient's life depends on the experience of the doctor.

The state of anaphylactic shock is easily confused with other diseases, main factor Diagnosis is the correct collection of anamnesis!

Plain radiography chest allows to detect inverstial pulmonary edema.

A biochemical blood test determines an increase in kidney samples (urea, keratin), liver enzymes (bilirubin, alkaline phosphatase, ALT, AST).

A complete blood count may indicate anemia (a decrease in the number of red blood cells) and leukocytosis (an increase in the level of white blood cells) with eosinophilia (an increase in the level of eosinophils).

ELISA is used to determine specific antibodies (Ig E, Ig G).

If the patient is not able to name the cause of the allergic reaction, he is recommended to conduct allergic tests with a consultation with an allergist.

First medical aid for anaphylactic shock: an algorithm of actions

Lay a person on a flat surface, slightly raise his legs (for example, put a pillow or a blanket rolled up with a roller under his feet).

Turn your head to the side to prevent aspiration of vomit, pull dentures out of your mouth.

Open a door or window to let fresh air into the room.

Carry out measures aimed at stopping the entry of the allergen into the patient's body - remove the sting with poison, apply a cold compress to the injection or bite site, apply a pressure bandage above the bite site and other actions.

Feel the victim's pulse: first on the wrist, and in case of absence - on the femoral or carotid arteries. If a pulse cannot be detected, a indirect massage hearts - fold your hands into a castle, put them in the middle of the sternum and carry out rhythmic pushes, up to 5 cm deep.

Check if the patient is breathing: follow the movements of the chest, lean a mirror against the victim's mouth. In the absence of breathing, it is recommended to start artificial respiration using the "mouth-to-mouth" or "mouth-to-nose" technology, directing the air flow through a handkerchief or napkin.

Transport the person to the hospital on their own or call an ambulance immediately.

Algorithm of emergency medical care in anaphylactic shock:

Monitoring of vital functions - electrocardiography, determination of oxygen saturation, measurement of pulse and blood pressure.

Ensure the patency of the respiratory tract - remove vomit from the mouth, remove lower jaw according to the Safar triple dose, perform tracheal intubation. In case of Quincke's edema or spasm of the glottis, a conitocomy is recommended (performed by a doctor or paramedic in emergency cases, the essence of this manipulation is to cut the larynx between the cricoid and thyroid cartilages to ensure the supply of fresh air) or tracheotomy (performed only in medical medical institutions, the doctor performs an incision of the tracheal rings).

The introduction of adrenaline in a proportion of 1 ml of a 0.1% solution of adrenaline hydrochloride per 10 ml of saline. If there is a certain place through which the allergen has entered the body (injection site, bite), it is advisable to prick it subcutaneously with a diluted adrenaline solution. Next, you should enter from 3 to 5 ml of the solution sublingually (under the root of the tongue, since it is well supplied with blood) or intravenously. The remainder of the adrenaline solution must be diluted in 200 ml of saline and continue to be administered intravenously, while controlling the level of blood pressure.

The introduction of glucocorticosteroids (hormones of the adrenal cortex) - most often used prednisolone (dosage 9-12 mg) or dexamethasone (dosage 12-16 mg).

The introduction of antihistamine drugs - first by injection, then with the transition to tablet forms (tavegil, suprasin, diphenhydramine).

Inhalation of humidified oxygen (40%) at a rate of 4 to 7 liters per minute.

When determining respiratory failure, the introduction of aminophylline (5-10 ml) and methylxanthines - 2.4% is recommended.

As a result of the redistribution of blood, acute vascular insufficiency develops. At the same time, the introduction of colloidal neoplasmagel (gelofusin) and crystalloid (sterofundin, plasmalite, ringer-lactate, ringer) solutions is recommended.

In order to prevent pulmonary and cerebral edema, diuretics are prescribed - minnitol, torasemide, furosemide.

In the cerebral form of analphylactic shock, tranquilizers are prescribed (seduxen, relanium, sibazon), anticonvulsants - 25% magnesium sulfate (10-15 ml), 20% sodium oxybutyrate (GHB) 10 ml.

Anaphylactic shock: How not to die from allergies? video:

Consequences of anaphylactic shock

Not a single disease passes without a trace, such is anaphylactic shock. After elimination of respiratory and cardiovascular insufficiency, the following symptoms may persist in the patient:

Abdominal pain, vomiting, nausea, heart pain, shortness of breath, chills, fever, muscle and joint pain, weakness, lethargy, lethargy.

Prolonged hypotension (low blood pressure) - treated with prolonged administration of vasopressors: norepinephrine, dopamine, mezaton, adrenaline.

Pain in the hearts as a result of ischemia of the heart muscle - the introduction of cardiotrophics (ATP, riboxin), antihypoxants (mexidol, thiotriazoline), nitrates (nitroglycerin, isoket) is recommended.

Decrease in intellectual functions due to prolonged hypoxia of the brain, headache - vasoactive substances (cinnarizine, ginkgo biloba, cavinton), nootropic drugs (citicoline, piracetam) are used.

If infiltrates occur at the injection or bite site, local treatment is recommended - ointments and gels with a resolving effect (lyoton, troxevasin, heparin ointment).

Sometimes after anaphylactic shock, late complications occur:

Diffuse lesion nervous system, vestibulopathy, glomerulonephritis, neuritis, allergic myocarditis, hepatitis - often cause death.

Approximately 2 weeks after shock, angioedema, recurrent urticaria and the development of bronchial asthma may occur.

Repeated contact with allergenic drugs leads to the development of diseases such as systemic lupus erythematosus, periarteritis nodosa.

Anaphylactic shock, what is it and how to deal with it, video:

Primary prevention of shock

It is based on preventing the body from coming into contact with the allergen:

production quality control medical devices and medicines;

exception bad habits(substance abuse, drug addiction, smoking);

fight against chemical products polluting the environment;

combating the one-time prescription of a huge number of medical drugs by doctors;

prohibition on the use of certain food additives(glumanate, agar-agar, bisulfites, tartrazine).

Secondary prevention of shock

Promotes early detection and timely treatment diseases:

conducting allergological tests in order to determine a specific allergen;

timely treatment of eczema, hay fever, atopic dermatitis, allergic rhinitis;

indication of intolerable medications in red paste on the outpatient card or the title page of the medical history;

careful collection of allergic anamnesis;

observation of patients for at least half an hour after the injection;

carrying out sensitivity tests of the body in relation to the drugs administered intramuscularly or intramuscularly.

Tertiary prevention of shock

Prevents the manifestation of recurrence of the disease:

the use of a mask and sunglasses during the flowering period of plants;

careful control of food intake;

removal of unnecessary upholstered furniture and toys from the apartment;

ventilation of premises;

frequent cleaning of rooms to remove insects, mites, house dust;

compliance with the rules of personal hygiene.

Photo of the consequences:

How can doctors minimize the risk of anaphylactic shock in a patient?

In order to prevent the disease, the main aspect is a closely collected anamnesis of diseases and the patient's life. To minimize the risk of its development from taking medications, it is necessary:

Carry out the appointment of any drugs strictly according to indications, in the optimal dosage, taking into account compatibility and tolerability.

The age of the patient must be taken into account. Single and daily doses of antihypertensive, sedative, neuroplegic, cardiac drugs for the elderly should be reduced by 2 times compared with doses for middle-aged people.

Do not administer multiple drugs at the same time, only one drug. It is possible to prescribe a new drug only after testing for its tolerability.

Prescribing multiple drugs that are identical in chemical composition pharmacological action, the risk of allergic cross-reactions should be considered. For example, if promethazine is intolerant, it is forbidden to prescribe its antihistamine derivatives (pipolene and diprazine), if you are allergic to anestezin and procaine, there is a high probability of intolerance to sulfonamides.

Without fail, antibiotics must be prescribed, taking into account the data of microbiological studies and determining the sensitivity to microorganisms.

As a diluent for antibiotics, it is better to use distilled water or saline, since the use of procaine often causes allergic reactions.

When treating, take into account the functional state of the kidneys and liver.

Monitor the content of eosinophils and leukocytes in the patient's blood.

Before drug therapy, patients who are prone to developing anaphylactic shock 3-5 days and 30 minutes before the administration of the drug should be given second and third generation antihistamines (Telfast, Semprex, Claritin), calcium and corticosteroids - according to indications.

In order to be able to apply a tourniquet in case of shock above the injection, the first injection of the drug (1/10 of the dose, antibiotics - at a dose of less than 10,000 units) should be injected into the upper third of the shoulder. If signs of intolerance appear, it is necessary to tightly apply a tourniquet above the injection site until the pulse stops below the application site, prick the injection site with an adrenaline solution (calculated as 1 ml of 0.1% adrenaline together with 9 ml of saline), cover this area with ice or apply a cloth soaked cold water.

In the treatment rooms there should be anti-shock first aid kits and tables containing a list of medicines with common antigenic determinants that cause cross-allergic reactions.

Rooms for patients with anaphylactic shock should not be located near manipulation rooms. It is forbidden to place patients who have experienced repeated anaphylactic shock in the same room with those who are being injected with drugs, allergic at the first.

To prevent the occurrence of the Arthus-Sakharov phenomenon, the injection site should be monitored (redness, swelling, itching of the skin, with repeated injections in one area - skin necrosis).

Patients who have suffered anaphylactic shock at discharge from the hospital are marked with red paste on the title page of the medical history as “anaphylactic shock” or “ drug allergy».

After discharge, patients who have undergone anaphylactic shock are referred to doctors at the place of residence for dispensary registration and receiving hyposensitizing and immunocorrective treatment.

Forms of anaphylactic shock

Anaphylactic shock is the most severe form of an allergic reaction, which is accompanied by impaired functioning of the circulatory and respiratory systems. With the subsequent development of the described condition, it can be fatal.

This circumstance causes interest in what stages and forms of anaphylactic shock exist. It is very important to know the first symptoms of the development of this allergic reaction and be able to distinguish between them. Early treatment can help prevent possible complications diseases.

Modern medicine distinguishes several main stages in the development of anaphylactic shock:

1. immunological stage. At this stage, the formation hypersensitivity the human body to a particular substance. This stage begins after the allergen enters the body. It is then that specific immunoglobulins are released. The duration of such a period can be measured in days and months, and sometimes years. In this case, the symptoms of a painful condition may be completely absent.
2. immunochemical stage. The beginning of this stage is the secondary penetration of the element causing an allergic reaction into the body. There is a clear connection of elements with previously produced immunoglobulins, after which they are degranulated mast cells connective tissue and there is a release of biologically active components, including histamine, resulting in external manifestations of an allergic reaction.
3. pathophysiological stage. At this stage, the active influence of the previously released active components takes place. This stage is characterized by the appearance of itching and rash, mucous membranes swell, blood circulation is disturbed. With such sensitivity to allergens, the fastest possible transport of a person to the hospital is required.

Forms of anaphylactic shock may be different, they are accompanied by various signs. Depending on the symptoms, the following forms of anaphylactic shock are divided:

1. Typical allergic reaction. The symptoms are quite characteristic, in some parts of the body a rash appears, accompanied by severe itching. A person begins to experience a feeling of heaviness and aches in the body, as well as pain. This form is accompanied by causeless anxiety, depression and a strong fear of death. Circulatory system malfunctions, there is a drop in blood pressure, shortness of breath appears, in more rare cases there are cases of loss of consciousness and the work of the senses is disturbed. With further aggravation of the situation, breathing may stop.
2. Hemodynamic form, in which the development of all signs is closely related to the circulatory system.
3. asphyxic form. There are pronounced symptoms of insufficiency of organs and respiratory systems.
4. Abdominal form. All the main symptoms of this form are directly related to the organs. abdominal cavity. The patient has severe pain in the abdomen, vomiting may develop after nausea.
5. cerebral form. It is characterized by dysfunction of the central nervous system.

Various forms of anaphylactic shock can have a daily duration or end in a few minutes with a complete cessation of breathing. This explains the importance of providing the patient with all the necessary assistance in a timely manner.

Causes of anaphylactic shock

The reasons for this condition can be very different. It is customary to single out some of its main reasons:

1. The use of drugs is one of the most common causes of the onset and development of anaphylactic shock. It can be caused by antibiotics, in particular penicillin, bicillin, streptomycin. Often, allergic reactions occur even with the initial administration of medications, because when they enter the human body, the medications enter into contact with protein substances without any difficulty and form certain complexes with sensitizing properties. In this case, an intensive formation of antibodies occurs.
2. Another group of reasons is related to the fact that the human body may have already been sensitized beforehand, in particular, food products may be the reason for this. For example, it is well established that penicillin impurities can be found in milk, the same can be said about some vaccines. In some cases, cross-sensitization is observed, the reason for which is that many drugs are combined by similar allergenic characteristics.
3. Anaphylactic shock can develop due to the use of certain vitamins, in particular, this applies to B vitamins, as well as carboxylase.
4. The strongest allergens are considered to be animal hormones, such as insulin, ACTH and others, as well as iodine preparations and sulfonamides. Also, anaphylactic shock can be caused by blood and some of its components, such as immune sera and anesthetics, of general and local action.
5. The cause of anaphylactic shock can be the poisons of various insects that have entered the body with insect bites (bumblebees, wasps, bees). Various foods such as eggs, nuts, milk and fish can also cause anaphylactic shock.

It should be taken into account the fact that the dose of the allergen taken is not decisive. It can enter the human body in various ways, these can be intradermal diagnostic tests, ointments used, inhalations, the use of drugs for instillation.

Anaphylactic shock: symptoms

The definition of anaphylactic shock is rather difficult, since the reaction is polymorphic. Each case has its own symptoms and they are closely related to the cause of the condition.

According to the nature of the observed symptoms, three forms of anaphylactic shock are distinguished:

1. Lightning form. In such cases, the patient himself does not always have time to understand what exactly is happening to him. After the allergen enters the bloodstream, the disease develops rapidly. Development time can be limited to two minutes. From characteristic symptoms of a similar form, blanching of the skin and difficulty in breathing can be noted. Sometimes all the signs are there clinical death. The patient suddenly loses consciousness and develops heart failure. Often the result is the death of the patient.
2. Heavy form. Symptoms of anaphylactic shock are observed after 5-10 minutes after the allergen enters the bloodstream. A person's heart begins to hurt badly, he suffocates and feels an acute shortage of air. After the first symptoms, it is urgent to provide the patient with first aid. If first aid is not provided, the situation may end in the death of the patient.
3. Medium form. It is observed half an hour after the allergen is in the blood. The patient suddenly has severe headaches, a fever occurs, and rather unpleasant sensations are noted in the chest. Death in such cases is relatively rare.

General symptoms include:

1. The appearance of redness on the skin, urticaria occurs, swelling is visible on the skin.
2. Respiratory symptoms include shortness of breath, loud breathing noises, swelling in the upper airways, asthmatic attacks, itchy sensations in the nose, and coughing spells.
3. Cardiovascular symptoms include discomfort with palpitations, rapid pulse. There is a feeling that the heart is ready to “jump” out of the chest, it seems to be turning over in it. Behind the sternum begins strong pain and possible loss of consciousness.
4. Gastrointestinal symptoms are characterized by nausea, vomiting associated with loose stools, stomach cramps, and bloody streaks in the vomit.
5. Neurological symptoms can be described as feelings of anxiety, intense agitation, panic, and constant restlessness.

As a rule, anaphylactic shock is accompanied by a combination of a number of symptoms. They rarely appear separately.

The first symptoms of anaphylactic shock

Similar symptoms are observed most often within half an hour after the introduction of the allergen. Depending on how quickly the symptoms show up, one can judge how severe the state of shock will be. The more difficult the shock itself is, the more difficult the prognosis of the further clinical picture will become. There are many cases of death after the first action of the drug.

Various variations of the clinical picture of the considered shock are possible, but its most dangerous symptom, which is quite difficult to predict in a timely manner, is the rapid collapse of the heart. At the very beginning of the development of the process, the patient feels general weakness, stabbing sensations are felt in the face, and it also pricks strongly in the chest, on the palms and soles of the feet. Subsequently, there is a rapid unfolding of the clinical picture. Weakness sharply increases, against its background there is pressure behind the sternum, the patient begins to pursue various phobias that are difficult to eliminate. The patient suddenly becomes very pale, he has a large amount of cold sweat, there are pains in the abdomen. Often there is a rapid drop in blood pressure, while the pulse quickens and weakens, involuntary urinary incontinence and defecation are possible.

In some cases initial symptoms In the analyzed shock, patients had ringing in the ears, congestion, itching all over the body, rashes on the body, conjunctivitis, swelling of the ears, tongue, eyelids, after which there was a collapse of the heart and loss of consciousness.

The initial symptoms of the shock in question may vary, but there is always a very poor general condition of the sick person. At the same time, he urgently needs to provide him with qualified emergency medical care.

The clinical picture of anaphylactic shock is rather stormy. There is tightness and pressure in the chest, breathing becomes difficult and the person feels weak. A person begins to get very sick and dizzy, a strong heat is felt throughout the body. A person is sick, his eyesight is deteriorating, his tongue and limbs go numb, his ears are blocked. The skin all over the body begins to itch and edema appears on it.

Symptoms after anaphylactic shock

After the onset of anaphylactic shock, patients are frightened and show great anxiety. They breathe quite noisily and their breathing can be heard from a distance. The activity of the heart and blood vessels after the shock worsens significantly, blood pressure drops sharply, while the pulse quickens and becomes thready, it is poorly palpable. The patient turns pale sharply and quickly, cyanosis and acrocyanosis appear. Possible microcirculation disorders in severe forms if previously the patient had coronary heart disease, the development of coronary insufficiency is possible. The clinical picture is significantly aggravated.

After anaphylactic shock, spasms of smooth muscles are possible, resulting in bronchospasm. Respiratory failure may be due to angioedema of the larynx. The airways undergo obstruction, which is combined with pulmonary hypertension and increased vascular permeability. The result can be psychomotor agitation, turning into adynamia, as well as pulmonary edema. There may be loss of consciousness, accompanied by involuntary urination and defecation. Conducting a study using an electrocardiogram allows you to identify disruptions in the rhythms of cardiac activity, overload of various parts of the heart and coronary insufficiency. The heart may spontaneously stop due to a very severe, rapid shock. A lethal outcome is noted in every tenth case of anaphylactic shock.

Anaphylactic shock: first aid

It should be understood that care for anaphylactic shock is divided into pre-medical, medical and inpatient treatment. It is allowed to provide first aid to people who were in close proximity to the victim at the moment when he started allergic reactions. The first thing they should do is call an ambulance.

First aid for anaphylactic shock

First first aid in anaphylactic shock includes:

1. The patient is placed on his back, with a flat horizontal surface under him. His legs should be located above the level of the whole body, so a roller or other object should be placed under them. This is required to ensure blood flow to the patient's heart.
2. To ensure the flow of fresh air to the patient, it is required to open a window or window in the room.
3. The victim should unbutton his clothes, this will help to achieve the required level of freedom when breathing.
4. It is recommended to carefully monitor that there is nothing in the person’s mouth that could interfere with his full breathing. If a person has in his mouth removable dentures, you need to remove them. If there is a possibility of a sick person's tongue falling, you need to turn his head to the side and try to place it a little higher. If the victim has convulsive movements, it is recommended to put a previously prepared object between the jaws.
5. In the event that the fact of penetration into the body of a patient of a substance causing an allergic reaction due to an insect bite or injection is accurately established medical device, a tourniquet should be applied above the injection or bite area, it also makes sense to use ice to this place in order to limit the access of the allergen to the blood.

In addition, all the time until the arrival of an ambulance, it is necessary to carefully monitor the patient's condition. Special attention will be given to his breathing, pulse and pressure changes. If an antihistamine is available, it must be persuaded to take it. Tavegil, Fenkarol and Suprastin are suitable for this. After the ambulance team arrives, it is necessary to give them full information regarding the exact time of the onset of the described reaction in the patient, its symptoms, and the assistance that was provided.

First aid for anaphylactic shock

First aid in the development of an anaphylactic shock in a patient is provided to him in a stationary medical institution or by an ambulance team that has arrived. Medical assistance includes the following steps:

1. The patient must enter an adrenaline solution, a concentration of 0.1%. The solution can be administered both intravenously and intramuscularly, as well as under the skin of the patient, depending on the circumstances. In the event that anaphylaxis is noted after intravenous or other types of injections, as well as after an insect bite, it is recommended to apply an adrenaline solution to the site of penetration of the allergen. The concentration is as follows: one milliliter of adrenaline per ten milliliters of solution. Up to six points in a circle, 0.2 milliliters per point.
2. If the allergen has entered the body in another way, adrenaline must still be administered, since it is a direct histamine antagonist. The drug guarantees the narrowing of blood vessels and reduces the permeability of the walls of these vessels. In addition, it increases blood pressure. Mezaton and norepinephrine are analogous to this remedy. They are allowed to be used in cases where adrenaline is not at hand, but first aid must be provided for anaphylactic shock. Adrenaline should not be taken more than two milliliters per day. The dose is best administered fractionally, to ensure the uniformity of the action.
3. In addition to adrenaline, the patient is recommended the introduction of glucocorticoid hormones. These are hydrocortisone, dexamethasone, prednisolone. Best of all, if the administration is intravenous, it can be administered by drip or jet. The reduction should be diluted with a solution of sodium chloride.
4. Be sure to administer a large volume of fluid intravenously to the patient. This is due to the nature of anaphylactic shock, which is based on an acute lack of fluid in the human bloodstream. There are certain differences in the rate of administration of the solution to children and adults. For an adult, the solution can be administered faster than for a child.
5. When providing emergency medical care to a patient with anaphylactic shock, he should be provided with oxygen inhalation through a mask and free breathing. With laryngeal edema, an emergency tracheotomy should be performed.

If it is possible to establish intravenous access, the patient is given liquid already at the first stages of providing him with medical care. The introduction continues when transporting it to a medical facility with emergency and intensive care units.

First aid kit for anaphylactic shock

A complete first aid kit for anaphylactic shock requires the following drugs:

• prednisolone, the action of which is aimed at eliminating all signs of shock, since the drug is similar to substances produced by the human body;
• an antihistamine, antiallergic drug that prevents the body from producing histamine, a hormone that is responsible for such allergic reactions in the body;
• adrenaline, the action of which is aimed at the functioning of the muscles of the heart;
• aminofillin, a remedy that helps to expand the bronchi, as well as capillaries, which helps to improve blood oxygen saturation;
• diphenhydramine - an antihistamine with a calming effect;
• in addition, the first-aid kit should include related materials, such as bandages, cotton wool, alcohol, syringes, catheters and saline, everything that is required for the administration of drugs to the patient.

A first-aid kit with the described list of drugs should be in every medical office for procedures, as well as in medical offices at various enterprises. The composition of the first aid kit must be constantly replenished in accordance with the latest recommendations of the Ministry of Health.

Treatment of anaphylactic shock

Treatment of anaphylactic shock should begin as soon as the condition is suspected. You should start by stopping taking the drugs that caused the development of this process. If the needle remains in the vein. It is best to remove the syringe and continue the therapy through the needle. If the problem is an insect bite, you should remove its sting.

Then you need to accurately determine the time of penetration of the allergen into the body. In this case, the general condition of the patient should be taken into account and the initial clinical phenomena should be considered. Then you need to carefully lay the patient and raise his limbs. Be sure to turn your head to one side, push the lower jaw forward. This is a measure to prevent swallowing of his tongue and asphyxia with masses of vomiting. If there are dentures, they should also be removed. For a general assessment of the patient's condition, you should listen to him, find out what he complains about, measure his pressure. It is required to take into account the general nature of the patient's shortness of breath. Then you need to examine the skin of the patient. With a decrease in blood pressure by 20%, there is a possibility of further development of shock.

Be sure to ensure the access of oxygen to the patient. After that, a tourniquet is applied to the site of the subsequent injection of the solution. Ice is applied to the injection site. Be sure to inject with syringes or systemically. This is necessary for the qualitative elimination of the problem.

If you need to administer the medicine through the eyes and nose, you must first rinse them. Then inject two drops of adrenaline. When administered subcutaneously, a solution of adrenaline with a concentration of 0.1% is used. It is diluted in physiological saline. The system must be prepared in advance before the doctor arrives. Intravenous infusion involves the introduction of a solution of 400 milliliters. With difficult puncture, an injection should be injected into the soft tissue area under the tongue.

First, according to the jet principle, and then glucocorticosteroids are dripped. The most commonly used is prednisone. After that, diphenhydramine is used, at a concentration of 1%, then tavegil. All injections are intramuscular.

Principles of treatment of anaphylactic shock

By itself, anaphylactic shock or anaphylaxis is a borderline condition characterized by acute form currents. no impact external factors this state does not disappear. Help to the patient should be provided immediately, otherwise a sad ending is inevitable.

Most often, shock is caused by repeated contact with a component to which the human body is not disposed. In such cases, an allergic reaction is a common outcome due to high sensitivity. human body. Such a condition can be triggered by various substances, allergens of protein or polysaccharide origin, as well as compounds that turn into allergens after contact with the proteins of the human body.

Treatment of anaphylactic shock: drugs

The list of drugs for the treatment of anaphylactic shock may look like this:

• prednisolone, a hormone-based anti-shock drug, significantly reduces the risk of shock and has an effect from the first minute after the injection;
• antihistamine drugs, in particular tavegil or suprastin, that can eliminate the susceptibility of histamine receptors, which is the main substance that is released into the blood after the development of an allergic reaction;
• the hormonal drug adrenaline is required to stabilize the functioning of the heart in difficult conditions;
• diphenhydramine, an antihistamine drug, the action of which is double: it helps to block the further development of allergic reactions and provides suppression of excessive nervous excitation.

In addition to these funds, it is always necessary to keep syringes of the required size on hand, alcohol for wiping the skin before injecting, cotton wool, gauze and rubber bands, containers with saline for intravenous infusions.

Prevention of anaphylactic shock

Prevention of anaphylactic shock is reduced to the following recommendations:

1. At hand should always be drugs with which you can effectively provide first aid for anaphylactic shock. In addition, it is imperative to be able to use an automatic injector, with which adrenaline is injected.
2. You should resort to special methods protection from insect bites. Do not wear clothes with a predominance of bright colors, do not use perfume unnecessarily, do not eat unripe fruits on the street.
3. Try to avoid unnecessary contact with potential allergens whenever possible. This requires the ability to timely and correctly assess the purchased food products and the components that make up them.
4. If there is a need to eat food outside the home, it is necessary to make sure that it does not contain allergens in its composition.
5. When in industrial premises, contact with various skin allergens should be avoided.
6. Periodically, preventive diagnostic studies with the use of radiopaque substances should be carried out. In this case, the preliminary administration of ranitide, prednisolone, diphenhydramine and dexamethasone is mandatory.

In severe forms of anaphylactic reactions, beta-blockers should not be used. If there is such a need, the use of drugs of a different group is required.

103. Anaphylactic shock. Causes, clinic, diagnosis, emergency care.

Anaphylactic shock is immune response immediate type, which develops when the allergen is repeatedly introduced into the body and is accompanied by damage to its own tissues.

It should be noted that the development of anaphylactic shock requires prior sensitization of the body with a substance that can cause the formation of specific antibodies, which, upon subsequent contact with the antigen, lead to the release of biologically active substances that form the clinical symptoms of allergy, including shock. The specificity of anaphylactic shock lies in the immunological and biochemical processes that precede its clinical manifestation.

In the complex process observed in anaphylactic shock, three stages can be distinguished:

The first stage is immunological. It covers all changes in immune system arising from the moment the allergen enters the body; the formation of antibodies and sensitized lymphocytes and their combination with an allergen that has repeatedly entered or persists in the body;

The second stage is pathochemical, or the stage of formation of mediators. The stimulus for the emergence of the latter is the combination of the allergen with antibodies or sensitized lymphocytes at the end of the immunological stage;

The third stage is pathophysiological, or the stage of clinical manifestations. It is characterized by the pathogenic action of the formed mediators on the cells, organs and tissues of the body.

The reagin mechanism underlies the pathogenesis of anaphylactic shock. Reaginov it is called by the type of antibodies - reagins involved in its development. Reagins are mainly IgE, as well as immunoglobulins of the G/IgG class.

The mediators of anaphylactic reactions include histamine, serotonin, heparin, prostaglandins, leukotrienes, kinins, etc.

Under the influence of mediators, vascular permeability increases and the chemotaxis of neutrophilic and eosinophilic granulocytes increases, which leads to the development of various inflammatory reactions. An increase in vascular permeability promotes the release of fluid into the tissues from microvasculature and development of edema. Cardiovascular collapse also develops, which is combined with vasodilation. A progressive decrease in cardiac output is associated both with a weakening of vascular tone and with the development of secondary hypovolemia as a result of a rapidly increasing loss of plasma.

As a result of exposure to mediators, both large and small bronchi develop persistent bronchospasm. In addition to contraction of the smooth muscles of the bronchi, swelling and hypersecretion of the mucous membrane of the tracheobronchial tree are noted. The above pathological processes are the cause of acute airway obstruction. Severe bronchospasm can turn into an asthmatic state with the development of acute cor pulmonale.

clinical picture. Manifestations of anaphylactic shock are due to a complex set of symptoms and syndromes. Shock is characterized by rapid development, rapid manifestation, severity of the course and consequences. The type of allergen does not affect the clinical picture and the severity of the course of anaphylactic shock.

A variety of symptoms is characteristic: itching of the skin or a feeling of heat throughout the body (“as if burned by a nettle”), agitation and anxiety, sudden onset of general weakness, reddening of the face, urticaria, sneezing, coughing, shortness of breath, suffocation, fear of death, pouring sweat, dizziness , darkening in the eyes, nausea, vomiting, abdominal pain, urge to defecate, loose stools (sometimes mixed with blood), involuntary urination, defecation, collapse, loss of consciousness. On examination, the color of the skin may change: in a patient with a pale face, the skin acquires an earthy gray color with cyanosis of the lips and tip of the nose. Often attention is drawn to hyperemia of the skin of the trunk, rashes such as urticaria, swelling of the eyelids, lips, nose and tongue, foam at the mouth, cold clammy sweat. Pupils are usually narrowed, almost do not react to light. Sometimes there are tonic or clonic convulsions. The pulse is frequent, of weak filling, in severe cases it becomes filiform or not palpable, blood pressure falls. Heart sounds are sharply weakened, sometimes there is an accent of the II tone on the pulmonary artery. Heart rhythm disturbances, diffuse changes in myocardial trophism are also recorded. Above the lungs on percussion - a sound with a box shade, during auscultation - breathing with an extended exhalation, scattered dry rales. The abdomen is soft, painful on palpation, but without symptoms of peritoneal irritation. Body temperature is often elevated to subfebrile numbers. In the study of blood - hyperleukocytosis with a shift leukocyte formula to the left, pronounced neutrophilia, lympho- and eosinophilia. In the urine, fresh and altered erythrocytes, leukocytes, squamous epithelium and hyaline casts.

The severity of these symptoms varies. Conventionally, 5 variants of clinical manifestations of anaphylactic shock can be distinguished:

With a primary lesion of the cardiovascular system.

With a predominant lesion of the respiratory system in the form of acute bronchospasm (asphyxic or asthmatic variant).

With a primary lesion of the skin and mucous membranes.

With a predominant lesion of the central nervous system (cerebral variant).

With a primary lesion of the abdominal organs (abdominal).

There is a certain pattern: the less time has passed from the moment the allergen enters the body, the more severe the clinical picture of shock. The highest percentage of deaths is observed with the development of shock after 3-10 minutes from the moment the allergen enters the body, as well as with a fulminant form.

During anaphylactic shock, 2-3 waves of a sharp drop in blood pressure can be observed. Given this phenomenon, all patients who have undergone anaphylactic shock should be placed in a hospital. The possibility of developing late allergic reactions is not excluded. After shock, complications can join in the form of allergic myocarditis, hepatitis, glomerulonephritis, neuritis, diffuse damage to the nervous system, etc.

Treatment of anaphylactic shock

It consists in providing urgent assistance to the patient, since minutes and even seconds of delay and confusion of the doctor can lead to the death of the patient from asphyxia, severe collapse, cerebral edema, pulmonary edema, etc.

The complex of therapeutic measures should be absolutely urgent! Initially, it is advisable to administer all anti-shock drugs intramuscularly, which can be done as quickly as possible, and only if therapy is ineffective, the central vein should be punctured and catheterized. It was noted that in many cases of anaphylactic shock, even intramuscular administration of mandatory anti-shock agents is enough to completely normalize the patient's condition. It must be remembered that injections of all drugs should be made with syringes that have not been used to administer other medications. The same requirement applies to the drip infusion system and catheters in order to avoid recurrent anaphylactic shock.

The complex of therapeutic measures for anaphylactic shock should be carried out in a clear sequence and have certain patterns:

First of all, it is necessary to lay the patient down, turn his head to the side, push the lower jaw to prevent retraction of the tongue, asphyxia and to prevent aspiration of vomit. If the patient has dentures, they must be removed. Provide fresh air to the patient or inhale oxygen;

Immediately inject intramuscularly a 0.1% solution of adrenaline in an initial dose of 0.3-0.5 ml. It is impossible to inject more than 1 ml of adrenaline into one place, since, having a large vasoconstrictor effect, it also inhibits its own absorption. The drug is injected fractionally by 0.3-0.5 ml into different parts of the body every 10-15 minutes until the patient is removed from the collaptoid state. Mandatory control indicators for the introduction of adrenaline should be indicators of pulse, respiration and blood pressure.

It is necessary to stop the further intake of the allergen into the body - stop the administration of the drug, carefully remove the sting with a poisonous sac if a bee has stung. In no case should you squeeze out the sting or massage the bite site, as this enhances the absorption of the poison. Apply a tourniquet above the injection (stinging) site, if localization allows. Prick the injection site (stings) with a 0.1% solution of adrenaline in an amount of 0.3-1 ml and apply ice to it to prevent further absorption of the allergen.

When taking the allergen orally, the patient's stomach is washed, if his condition allows;

As an auxiliary measure to suppress an allergic reaction, the introduction of antihistamines is used: 1-2 ml of a 1% solution of diphenhydramine or 2 ml of tavegil intramuscularly (with severe shock, intravenously), as well as steroid hormones: 90-120 mg of prednisolone or 8-20 mg of dexamethasone intramuscularly or intravenously;

After completion of the initial measures, it is advisable to puncture the vein and insert a catheter for infusion of fluids and drugs;

Following the initial intramuscular injection of epinephrine, it can be administered slowly intravenously at a dose of 0.25 to 0.5 ml, previously diluted in 10 ml of isotonic sodium chloride solution. It is necessary to control blood pressure, pulse and respiration;

To restore the bcc and improve microcirculation, it is necessary to administer intravenous crystalloid and colloid solutions. An increase in BCC is the most important condition for the successful treatment of hypotension. The amount of fluids and plasma substitutes administered is determined by the magnitude of blood pressure, CVP and the patient's condition;

If persistent hypotension persists, it is necessary to establish a drip injection of 1-2 ml of a 0.2% norepinephrine solution.

It is necessary to ensure adequate pulmonary ventilation: be sure to suck out the accumulated secret from the trachea and oral cavity, and also, until the relief of a serious condition, carry out oxygen therapy; if necessary - IVL.

With the appearance of stridor breathing and the absence of the effect of complex therapy, it is necessary to immediately intubate the trachea. In some cases, according to vital indications, a conicotomy is done;

Corticosteroid drugs are used from the very beginning of anaphylactic shock, since it is impossible to predict the severity and duration of an allergic reaction. The drugs are administered intravenously.

Antihistamines are best administered after recovery of hemodynamic parameters, as they do not have an immediate effect and are not life-saving.

With the development of pulmonary edema, which is a rare complication of anaphylactic shock, it is necessary to carry out specific drug therapy.

In case of cardiac arrest, the absence of a pulse and blood pressure, urgent cardiopulmonary resuscitation is indicated.

For the complete elimination of the manifestations of anaphylactic shock, the prevention and treatment of possible complications, the patient after relief of the symptoms of shock should be immediately hospitalized!

The relief of an acute reaction does not yet mean the successful completion of the pathological process. It is necessary to constantly monitor the doctor during the day, as there may be repeated collaptoid conditions, asthmatic attacks, abdominal pain, urticaria, angioedema, psychomotor agitation, convulsions, delirium, in which urgent help is needed. The outcome can be considered favorable only after 5-7 days after an acute reaction.

Acute cor pulmonale. Causes, clinic, diagnosis, emergency therapy.

Symptoms of cor pulmonale:

Acute cor pulmonale develops within hours or days and is usually accompanied by symptoms of heart failure. At slower rates of development, a subacute variant of this syndrome is observed. The acute course of pulmonary embolism is characterized by the sudden development of the disease against the background of complete well-being. There is a sharp shortness of breath, cyanosis, pain in the chest, agitation. Thromboembolism of the main trunk of the pulmonary artery quickly, within a few minutes to half an hour, leads to the development state of shock, pulmonary edema. When listening, a large number of wet and scattered dry rales are heard. A pulsation can be detected in the second or third intercostal space on the left. Characterized by swelling of the cervical veins, progressive enlargement of the liver, its pain when probing. Often there is acute coronary insufficiency, accompanied by pain, rhythm disturbance and electrocardiographic signs of myocardial ischemia. The development of this syndrome is associated with the occurrence of shock, compression of the veins, dilated right ventricle, irritation of the nerve receptors of the pulmonary artery.

The further clinical picture of the disease is due to the formation of myocardial infarction, characterized by the occurrence or intensification of pain in the chest associated with the act of breathing, shortness of breath, cyanosis. The severity of the last two manifestations is less compared with the acute phase of the disease. A cough appears, usually dry or with scanty sputum. In half of the cases, hemoptysis is observed. In most patients, body temperature rises, usually resistant to antibiotics. Examination reveals a persistent increase heart rate, weakening of breathing and wet rales over the affected area of ​​the lung. Subacute cor pulmonale. Subacute cor pulmonale is clinically manifested by sudden moderate pain during breathing, rapidly passing shortness of breath and palpitations, fainting, often hemoptysis, symptoms of pleurisy. Chronic cor pulmonale. It is necessary to distinguish between compensated and decompensated chronic pulmonary heart.

In the compensation phase, the clinical picture is characterized mainly by the symptoms of the underlying disease and the gradual addition of signs of enlargement of the right heart. A number of patients have a pulsation in the upper abdomen. The main complaint of patients is shortness of breath, which is caused by both respiratory failure and the addition of heart failure. Shortness of breath increases with physical exertion, inhalation of cold air, in the supine position. The causes of pain in the region of the heart in cor pulmonale are metabolic disorders of the myocardium, as well as relative insufficiency of coronary circulation in the enlarged right ventricle. Pain in the region of the heart can also be explained by the presence of a pulmonary coronary reflex due to pulmonary hypertension and stretching of the pulmonary artery trunk. Examination often reveals blueness. An important sign of cor pulmonale is swelling of the jugular veins. Unlike respiratory failure, when the jugular veins swell during inhalation, with cor pulmonale, the jugular veins remain swollen both during inhalation and exhalation. Characterized by pulsation in the upper abdomen, due to an increase in the right ventricle.

Arrhythmias in cor pulmonale are rare and usually occur in combination with atherosclerotic cardiosclerosis. Blood pressure is usually normal or low. Shortness of breath in some patients with a pronounced decrease in the level of oxygen in the blood, especially with the development of congestive heart failure due to compensatory mechanisms. The development of arterial hypertension is observed. In a number of patients, the development of gastric ulcers is noted, which is associated with a violation of the gas composition of the blood and a decrease in the stability of the mucous membrane of the stomach and duodenal system. The main symptoms of cor pulmonale become more pronounced against the background of an exacerbation of the inflammatory process in the lungs. In patients with cor pulmonale, there is a tendency to lower the temperature, and even with an exacerbation of pneumonia, the temperature rarely exceeds 37 ° C. In the terminal stage, edema increases, there is an increase in the liver, a decrease in the amount of urine excreted, disorders of the nervous system occur (headaches, dizziness, noise in the head, drowsiness, apathy), which is associated with a violation of the gas composition of the blood and the accumulation of under-oxidized products.

Urgent care.

Peace. Give the patient a semi-sitting position.

To give an elevated position of the upper body, inhalation of oxygen, complete rest, the imposition of venous tourniquets on the lower limbs for 30-40 minutes.

Intravenously slowly 0.5 ml of a 0.05% solution of strophanthin or 1.0 ml of a 0.06% solution of corglycon in 10 ml of a 0.9% solution of sodium chloride, 10 ml of a 2.4% solution of aminophylline. Subcutaneously 1 ml of a 2% solution of promedol. With arterial hypertension - intravenously 1-2 ml of a 0.25% solution of droperidol (if promedol was not previously administered) or 2-4 ml of a 2% solution of papaverine, if there is no effect - intravenously drip 2-3 ml of a 5% solution of pentamin in 400 ml 0.9% sodium chloride solution, dosing the rate of administration under the control of blood pressure. With arterial hypotension (BP below 90/60 mm Hg, st.) - intravenously 50-150 mg of prednisolone, if there is no effect - intravenously 0.5-1.0 ml of 1% mezaton solution in 10-20 ml of 5% glucose solution (0.9% sodium chloride solution) or 3-5 ml of 4% dopamine solution in 400 ml of 0.9% sodium chloride solution.

Anaphylactic shock always develops suddenly and at lightning speed. Therefore, it requires equally lightning-fast action.

What is anaphylactic shock and why is it dangerous?

Anaphylactic shock is an extremely severe form of allergy.

As with any allergy, the body, faced with a substance that seems to be poison to it, begins to defend itself. And he does it so actively that he harms himself.

But in the case of anaphylaxis, the situation is special: the immune response to the irritant is so strong that not only the skin and mucous membranes, but also the digestive tract, lungs, the cardiovascular system. The consequences can be extremely unpleasant:

• Arterial pressure drops sharply.
• Tissue edema develops rapidly, including the larynx - breathing problems begin.
• The brain begins to experience acute oxygen starvation which can lead to fainting and further impairment of vital functions.
• Due to swelling and lack of oxygen, other internal organs also suffer.

This combination of symptoms is serious complications and can be deadly. Therefore, it is important to quickly recognize anaphylaxis and provide first aid.

How to recognize anaphylactic shock

The first and one of the most important points in the diagnosis is contact with the allergen. Be especially careful if the following symptoms develop after an insect, medication, or food. Even seemingly harmless peanut cookies can turn out to be an allergen.

Shock develops in two stages. The main symptoms-harbingers of anaphylaxis look like this:

• An obvious skin reaction is redness or, conversely, pallor.
• Tingling in the arms, legs, around the mouth, or all over the head.
• , itching in the nose, desire to sneeze.
• Labored and/or wheezing breathing.
• A lump in the throat that prevents you from swallowing normally.
• Abdominal pain, nausea, vomiting, diarrhea.
• Swollen lips and tongue.
• A clear feeling that something is wrong with the body.

Already at this stage it is necessary to take urgent measures (about them below). And even more urgent help is needed if anaphylaxis reaches the second, shock stage. Its symptoms:

• Dizziness.
• Sharp weakness.
• Paleness (the person literally turns white).
• The appearance of cold sweat.
• Severe shortness of breath (hoarse, noisy breathing).
• Sometimes .
• Loss of consciousness.

3 main rules of first aid for anaphylactic shock

1. Call an ambulance

This must be done as soon as possible. FROM mobile phone call 103 or 112.

2. Urgently inject adrenaline

Adrenaline (epinephrine) is administered intramuscularly to raise the fallen blood pressure. This drug is sold in pharmacies in the format of autoinjectors - automatic syringes that already contain the required dose of the drug. Even a child can make an injection with such a device.

As a rule, the injection is made in the thigh - the largest muscle is located here, it is difficult to miss.

Don't Be Afraid: Adrenaline Won't Hurt Severe Allergic Reaction Treatment with false alarms. But if not false, it can save a life.

People who have already experienced anaphylactic reactions often carry epinephrine autoinjectors with them. If the victim is still conscious, be sure to ask if he has the drug. There is? Follow the instructions above.

Accept antihistamines there is no point: anaphylactic shock develops very quickly and they simply do not have time to act.

If the victim did not have adrenaline, and there are no pharmacies nearby, it remains to wait for the ambulance to arrive.

3. Try to alleviate the person's condition

• Lay the victim on their back with their legs elevated.
• If possible, isolate the person from the allergen. If you notice an allergic reaction following an insect bite or drug injection, apply a bandage over the bite or injection site to slow the spread of the allergen throughout the body.
• Do not give the victim to drink.
• If vomiting is present, turn the head to the side to prevent the person from choking.
• If the person has lost consciousness and stopped breathing, start (if you have the appropriate skills) and continue until the arrival of the paramedics.
• If the condition of the victim has improved, still make sure that he waits for an ambulance. Anaphylactic shock requires additional examinations. In addition, a recurrence of the attack is possible.

Fortunately, in most cases, when timely medical care is provided, anaphylaxis recedes. According to American statistics, a lethal outcome is fixed Fatal Anaphylaxis: Mortality Rate and Risk Factors only 1% of those who were hospitalized with a diagnosis of anaphylactic shock.

What can cause anaphylactic shock

There is no point in listing reasons. Allergy is an individual reaction of the body, it can develop to factors that are completely harmless to other people.

But for the letterheads, here is a list of the most common triggers Allergy Attacks and Anaphylaxis: Symptoms and Treatment resulting in anaphylactic shock.

• Food. Most often - nuts (especially peanuts and forest), seafood, eggs, wheat, milk.
• Insect bites - bees, wasps, hornets, ants, even mosquitoes.
• Dust mites.
• Mold.
• Latex.
• Some medicines.

Who is susceptible to anaphylactic shock

The risk of developing anaphylactic shock is high in those Anaphylactic Shock: Symptoms, Causes, and Treatment, who:

• Already experienced a similar allergic reaction.
• Has any type of allergy or.
• Has relatives who have had anaphylaxis.

If you belong to one of the listed risk groups, consult a therapist. You may need to buy an adrenaline auto-injector and carry it with you.

Good day, dear readers!

In today's article, we will consider with you one of the most dangerous types of allergic reaction for human life, like anaphylactic shock, as well as its symptoms, causes, types, algorithm for rendering emergency care, treatment and prevention of anaphylactic shock .

What is anaphylactic shock?

Anaphylactic shock (anaphylaxis)- an acute, rapidly developing and deadly organism for an allergen.

Anaphylactic shock is an immediate type of allergic reaction, most often manifested when the allergen enters the body again. The development of anaphylaxis is so rapid (from a few seconds to 5 hours from the beginning of contact with the allergen) that with the wrong emergency algorithm, death can occur literally within 1 hour!

As we have already noted, anaphylactic shock, in fact, is a superstrong (hyperergic) response of the body to the ingestion of a foreign substance. Upon contact of the allergen with antibodies that have the functions of protecting the body, special substances are produced - bradykinin, histamine and serotonin, which contribute to disruption of blood circulation, disruption of the muscular, respiratory, digestive and other body systems. Due to disruption of normal blood flow, organs throughout the body do not receive the necessary nutrition - oxygen, glucose, nutrients, starvation occurs, incl. brain. At the same time, it falls, dizziness appears, loss of consciousness may occur.

Of course, the above manifestations are not a normal reaction of the body to an allergen. What is observed with anaphylaxis indicates a failure in the immune system, therefore, after providing emergency care for anaphylactic shock, therapy is also aimed at normalizing the functioning of the immune system.

According to statistics, anaphylaxis is fatal in 10-20% of cases if it was caused by the introduction medicinal product(drug allergy). In addition, from year to year, the number of manifestations of anaphylactic shock is growing. This is primarily due to the deterioration of the general state of health. a large number people, the low quality of modern food and the thoughtless use of medicines without consulting doctors. Also, statisticians note that the manifestation of anaphylaxis is more seen in women and young people.

For the first time, the term "Anaphylactic shock" appeared in the scientific world at the beginning of the 20th century, when it was introduced into use by 2 people - Alexander Bezredka and Charles Richet.

Anaphylactic shock. ICD

ICD-10: T78.2, T78.0, T80.5, T88.6;
ICD-9: 995.0.

The cause of anaphylactic shock can be an incredible number of different allergens, so we note the most common of them:

Insect bites

Animal bites

Food

Due to the fact that the body, due to various GMO products, does not receive the required amount of vitamins and, as well as the replacement of normal food by many people - products fast food and others, many people experience various disorders in the body. In addition, allergies to various products are increasingly observed, while about 30% of allergy sufferers are prone to anaphylaxis.

Foods with increased allergenicity include:

• nuts and their derivatives - peanuts and peanut butter, almonds, hazelnuts, etc.;
• seafood - shellfish, crabs, some types of fish;
• dairy products, eggs;
• berries and fruits - citrus fruits, strawberries, grapes, bananas, pineapples, pomegranates, raspberries, apricots, mangoes;
• other products: tomatoes, chocolate, green pea, .

Medical preparations

Due to the rapid development of the mass media (media), many people, without consulting their doctor, often unwisely use certain drugs that can not only cure, but also significantly worsen a person's health. You need to understand that some drugs are prescribed only in combination with other means, but all the subtleties are usually prescribed by the doctor on the basis of an examination and a thorough diagnosis of the patient.

Consider medications that carry the risk of developing anaphylaxis:

Antibiotics, especially penicillin ("Ampicillin", "Bicillin", "Penicillin") and tetracycline series, sulfonamides, "", "Streptomycin", etc. The statistics of cases of anaphylaxis is 1 to 5000.

10. In case of cardiac arrest, begin to do artificial ventilation of the lungs and.

First aid for anaphylactic shock

The following measures are taken if the condition of the victim does not improve, but rather worsens.

1. Intramuscularly and intravenously continue to inject a solution of adrenaline, in dosages for adults - 0.3-0.5 ml, for children - 0.05-0.1 ml / year of life. The frequency of injections is 5-10 minutes. The dose may be increased if blood pressure continues to fall and clinical manifestations intensify. A single dose of 0.1% adrenaline solution should not exceed 2 ml.

2. If the blood pressure level does not return to normal, it is necessary to start intravenously injecting 0.2% noradrenaline ("Dopamine", "Mezaton"), at a dose of 1.0-2.0 ml per 500 ml of 5% glucose solution. You can use saline instead of glucose.

3. Glucocorticosteroids are administered intravenously:

• "Dexamethasone": adults - 8-20 mg, children - 0.3-0.6 mg / kg;
• "Prednisolone": adults - 60-180 mg, children - 5 mg / kg.

Hormones are administered over 4-6 days.

4. After normalization of blood pressure, an antihistamine is administered intramuscularly:

• "Suprastin" (2% solution): adults - 2.0 ml, children - 0.1-0.15 ml / year of life;
• "Tavegil" (0.1% solution): adults - 2.0 ml, children - 0.1-0.15 ml / year of life;

Symptomatic treatment

With bronchospasm. A 2.4% solution of aminophylline in saline is administered intravenously, at a dose for adults - 10.0 ml, for children - 1 ml / year of life. Additionally, you can enter respiratory analeptics, cardiac glycosides ("Digoxin", "Strophanthin").

When vomit enters Airways begin their suction, apply oxygen therapy.

Anaphylaxis from penicillin antibiotics intramuscularly injected 1670 IU of penicillinase, diluted with 2 ml of saline.

After providing emergency medical care for anaphylactic shock, the patient is subject to hospitalization, with a minimum period of 10 days. During inpatient observation and symptomatic treatment, the patient, after anaphylactic shock, may still experience late allergic reactions. At this time, it is very important to receive qualified medical care.

Treatment of anaphylactic shock

After anaphylactic shock, symptomatic treatment of the patient is continued, which includes:

Taking antihistamines, which are used for outbreaks of an allergic reaction - "", "", "".

Taking decongestants, which are applied in allergic reactions in respiratory system- "Xylometazoline", "Oxymetazoline". Contraindications - nursing mothers, children under 12 years of age, hypertension.

The use of leukotriene inhibitors, which relieve swelling of the respiratory system, eliminate bronchospasm - "Montelukast", "Singulair".

Hyposensitization. This method implies a systematic gradual introduction of small doses of a large number of allergens, which is aimed at developing the body's resistance to allergens, and, accordingly, minimizing repeated attacks of the development of acute allergic reactions, including anaphylactic shock.

Prevention of anaphylactic shock

Prevention of anaphylactic shock includes the following rules and recommendations:

- storage of a medical record indicating all information about allergic reactions to a particular substance;

- if you are allergic, always carry an allergy passport and a set of medicines for emergency care: antihistamines (Suprastin, Tavegil), tourniquet, adrenaline solution with saline, cardiac glycosides (Digoxin, Strophanthin).

- do not use medications without consulting a doctor, especially injections;

— folk methods use the treatment of diseases only after consulting a doctor;

- try to wear clothes mostly from natural fabrics;

- use household cleaners with gloves;

- use chemical substances(varnishes, paints, deodorants, etc.) only in well-ventilated areas;

- exclude immunotherapy with uncontrolled;

- avoid contact with stinging insects - wasps, bees, hornets, bumblebees, as well as other animals - snakes, spiders, exotic frogs and other representatives of exotic fauna;